Whilst not primarily a chest disease, Osler Weber Rendu (Otherwise known as Hereditary hemorrhagic telangiectasia) is a rare genetic condition of the arteries that may manifest anywhere in the body. In this disorder, the switch that controls blood-vessel growth cannot spontaneously turn off. Abnormal clusters and knots of vessels form. People with this condition often have small blood vessel malformations that cause red or purple spots on the lips or tongue. These are telangiectasia, sometimes known as birthmarks, and are commonly seen in other conditions.
The walls of the abnormal vessels are thin, weak, and fragile, and easily bleed after minor trauma. Internal blood-pressure may make them blow up like a small balloon called an aneurysm.
Millions of fine capillaries in normal lungs act to filter out any blood clots that may arise in the body. In OWR abnormal connections can also occur between arteries and veins that allow blood to shunt from one to the other. In this way, blood clots normally filtered in the lungs may cross over into the arterial system. Blood-flow then sweeps them along to lodge elsewhere in the body, including the brain where they block an artery causing a stroke.
The chest X-ray in this image comes from a person with this condition. I have retained quite a lot of the original X-ray in the picture and the complex blood vessels remain visible. People may carry the gene for the condition and never express it, and so it is impossible to know who carries this. I have therefore included several people in a crowd to represent the random nature of genetic conditions generally, and in the background complex pipework in a factory with valves and dials represent the arteries and veins of the body.
When damage occurs to the wall of a normal blood vessel and bleeds into body tissues, clotting blood generally causes the hemorrhage to stop. Leaked blood disperses and is slowly re-absorbed. However if damage occurs to the inner layer of the vessel whilst the soft, thin outer coating is unbroken, the pressure of blood into the area may cause the thin tissue layer to blow up like a balloon and form a cavity. Pressure does not allow the space to collapse, blood swirls around keeping it open and, indeed, increasing its size. This is known as a pseudo-aneurysm.
The Chest X-ray in this image is from a 40-year-old driver one month after a major accident. He complained of a swelling above the right collarbone (clavicle) and was unable to move his right arm. An X-ray study of the artery – an angiogram – showed a large pseudo-aneurysm.
In my image, I have overlaid the man’s chest X-ray with the angiogram study of the arteries of his right arm. The artery and the aneurysm are depicted in multiple layers and I have used the colour scheme to indicate the dangerous nature of this condition.
Chest 155; Atherosclerosis – alternative title Turtle Rock
The series of images that build up this picture were taken on an excursion to Turtle Rock; an ancient cave close to where I live with Aboriginal paintings on walls and roof. During the walk I was much taken by the patterns of dried and flaking bark clinging to the stems and branches of white eucalyptus trees that we call Ghost Gums. It reminded me of the angiographer’s nightmare, unstable fatty deposits on internal walls of arteries – arterial fibro-fatty plaque – and the dangers of advancing a catheter through a plaque ridden vessel. The plaque cap, like the eucalyptus bark, is often weak and prone to rupture. A catheter-tip may dislodge small pieces of the fragile cap causing it to embolise to the periphery of the artery being investigated. Loss of the fibrous cap also exposes thrombogens that may cause thrombosis within the vessel itself. The thrombi may occlude the vessel, or could detach, move into the circulation, and themselves embolise further downstream. Angiographic techniques and catheters have been devised to minimise these risks.
The index chest X-ray was from an elderly man with calcified plaque lining the aortic arch.
Chest 155, Parkland
The pictures that comprise this image were taken in parkland, in Queensland, in a wet, humid area. These conditions are ideal for the growth of environmental fungi. Fungal organisms are indispensable in the natural ecosystem and to life on this planet. They benefit humans, plants and animals, but they also interact in pathological ways. Of the many thousands of identified fungi only a dozen or so are “life-threatening” to humans, indeed many benefit humans such as penicillin. There are very few “primary” human fungal pathogens, e.g. coccidiomycosis and histoplasmosis.
Fungi can however cause devastating disease in plants and animals, though very few can do both. Cryptococcus gattii is one that infects both humans and animals but is non-pathogenic in plants. Humans are largely resistant to fungal disease, possibly due to the high basal temperature of mammals which fungi do not like.
The incidence of fungal disease in humans is however increasing, most likely due to the growing population of immuno-compromised people e.g. people who have received organ transplants, people on long term steroid treatment, and of course HIV/AIDS, and once established these diseases are difficult to treat.
The X-ray, which is hardly visible in this image, is from a woman who contracted Cryptococcus gattii in South-East Asia. This causes a deadly infection of both lung and brain. It was initially a disease of tropical and sub-tropical regions of Asia and Australia but is recognized as an emerging disease in Canada.
Chest 154; Purple headed mountain
Using Photoshop I drew the background hills and vegetation in a soft water-colour type of picture, then backed it with colour and texture. Finally with a chest X-ray of a man with severe emphysema. Just the sort of person whose respiratory reserve is so small that a small chest infection sends them into respiratory failure and the skin goes blue-purple with with severe cyanosis.
Simplify – Simple joys
This component of the challenge was to simplify. For my base Image I took a single coronal slice from a Computed Tomography (CT) slice of the face. Only the tip of the nose, the lips and tip of the chin are included.
Simplify – a simple CT scan
Set against a blue background it gives the impression of a stone pagoda in a Zen garden. simple and beautiful. I wanted to introduce colour but maintain the simple shapes so superimposed it on part of an oil painting which gave texture, and then included the chest X-ray of a normal child. Almost all of the X-ray is subsumed into the base layers leaving only a gentle shadowy halo around the central figure that now looks like a geisha.
This challenge had ten components, Patterns is one I liked. I find rigid patterns too stiff and formal and want some chaos out of which a pattern arises. I found this in a picture of rusty old bed-springs Taken some years ago.
Patterns in bedsprings
The repetitive swirls and wiggly lines was most appealing. I overlaid this with a study of the sun setting through a flamboyant tree in flower (We call it poinciana in Australia). It includes a Chest X-ray of a child which almost disappears into the background, but provides enough alteration in the texture to make a frame around the bright centre. There was little photo processing other than the overlain images and the blending mode to bring the components through.